• Keun-Ho Park, Myung Ho Jeong, Youngkeun Ahn, Sang Sik Jung, KimMoo HyunMH, Hyoung-Mo Yang, Junghan Yoon, Seung Woon Rha, Keum Soo Park, Kyoo Rok Han, Byung Ryul Cho, Kwang Soo Cha, Byung Ok Kim, Min Soo Hyon, Won-Yong Shin, Hyunmin Choe, Jang-Whan Bae, Hee Yeol Kim, and Trans-Radial Intervention Registry Investigators.
• Chonnam National University Hospital, Gwangju, Korea.
• J. Korean Med. Sci. 2013 Sep 1; 28 (9): 1307-15.

AbstractThe aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.

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